Anorexia

Anorexia is classified as a mental health disorder in which a person maintains a body weight that is significantly below what is considered normal for their age, height, and health. This low body weight results from an intense drive for thinness and a relentless pursuit of control over food intake. People with anorexia may perceive themselves as overweight even when they are severely underweight. This misperception of body image—known as body dysmorphia—reinforces the behaviors that perpetuate the illness.

The disorder is not solely about food or weight; it often represents a deeper struggle with self-esteem, identity, and emotional regulation. For many, restricting food offers a way to cope with an environment, experience or emotional state that feels intolerable. Over time, this cycle of restriction and distorted thinking can cause severe physical complications and emotional distress.

The causes of anorexia are multifactorial, involving a combination of genetic, psychological, environmental, and social influences.

Genetic and biological factors

Research suggests that genetics plays a role in the development of anorexia. Individuals with a family history of eating disorders, depression, or anxiety are at a higher risk. Biologically, imbalances in brain chemicals such as serotonin and dopamine may affect mood regulation, appetite, and impulse control, contributing to disordered eating behaviors.

Psychological factors

Anorexia often coexists with other mental health conditions, such as anxiety, obsessive-compulsive disorder (OCD), or perfectionism. Many people with anorexia have an intense need for control and are highly self-critical. Low self-esteem, fear of failure, and feelings of inadequacy can also increase vulnerability. For some, restrictive eating becomes a coping mechanism to manage emotional distress or trauma.

Sociocultural influences

Society’s emphasis on thinness, beauty, and achievement can reinforce body dissatisfaction. Media portrayals that glorify certain body types can distort how individuals perceive their own appearance. Social media, in particular, can amplify comparison and pressure to maintain an “ideal” image. Cultural factors may also influence how body size and weight are valued, shaping beliefs about self-worth and acceptance.

Family and environmental factors

Family dynamics can also contribute to the development of anorexia. Families that overemphasize appearance, success, or control may unintentionally reinforce unhealthy thought patterns. In some cases, individuals who grow up in environments marked by conflict, neglect, or high expectations may turn to food control as a means of asserting independence or managing anxiety.

Anorexia affects both the body and the mind. The physical signs may be easier to recognize, but the psychological symptoms often appear first.

Physical symptoms include:

• Significant and rapid weight loss
• Fatigue, dizziness, and fainting
• Brittle hair and nails
• Dry, yellowed skin
• Feeling cold frequently due to low body temperature
• Irregular or absent menstrual cycles (amenorrhea)
• Slowed heart rate and low blood pressure
• Gastrointestinal issues such as constipation or bloating
• Muscle weakness or loss of muscle mass

Behavioral and emotional symptoms include:

• Intense fear of gaining weight, even when underweight
• Preoccupation with calories, dieting, and food rituals (cutting food into tiny pieces, avoiding certain foods)
• Distorted body image—believing they are overweight despite being underweight
• Denial of hunger or refusal to eat in front of others
• Excessive exercise or physical activity
• Withdrawal from friends, family, and previously enjoyed activities
• Mood swings, irritability, and difficulty concentrating
• Persistent feelings of guilt or shame around eating or body image

Over time, these behaviors can have life-threatening consequences. Malnutrition affects every organ in the body, including the heart, kidneys, and brain. Bone density decreases, increasing the risk of fractures and osteoporosis. The longer anorexia goes untreated, the greater the likelihood of permanent health complications.

Diagnosing anorexia involves a comprehensive evaluation that includes medical, psychological, and behavioral assessments. Because individuals with anorexia often conceal their symptoms or minimize their behaviors, early detection can be challenging. However, timely intervention greatly improves recovery outcomes.

A healthcare professional, such as a physician, therapist, or psychiatrist, will typically begin by reviewing the individual’s medical history, weight patterns, eating habits, and exercise behaviors. Medical providers, such as pediatricians, can conduct physical exams and laboratory tests to evaluate the effects of malnutrition on vital organs.

Common diagnostic criteria include:

• Restriction of food intake leading to significantly low body weight
• Intense fear of gaining weight or persistent behaviors that interfere with weight gain
• Distorted perception of body weight or shape, or an inability to recognize the seriousness of low body weight

Mental health professionals use criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to confirm the diagnosis. They will also assess for co-occurring disorders such as anxiety, depression, or obsessive-compulsive traits, which frequently accompany anorexia.

Recognizing the signs of anorexia early can be lifesaving. Family members, friends, teachers, coaches, and healthcare providers often play a critical role in identifying concerning behaviors and encouraging individuals to seek help. Because denial is common, loved ones should approach the topic with empathy rather than judgment. Creating a supportive, non-confrontational environment can help the individual feel safe discussing their struggles and begin the healing process.